Self in-fusing pedicle screw implant

ABSTRACT

An anchoring system implantable in bone. The anchoring system includes a screw having a screw head, a screw shaft, a plurality of interface elements, each adjacent pair of the interface elements has an interface by-pass channel disposed therebetween, a boring ring that includes cutting teeth and a ring by-pass channel, and a coupling assembly that is adjustable with respect to a longitudinal axis of the screw.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/831,980, filed Aug. 21, 2015, which is incorporated by referenceherein in its entirety for all purposes.

FIELD OF THE DISCLOSURE

The present disclosure relates to bone fixation devices that may includea rod and a bone screw with a variable angle coupling element; and, moreparticularly, to an anchoring system that aids in the correction of, forexample, posterior segmental fusion by adding or facilitating theaddition of a bone graft to an implant site.

BACKGROUND OF THE DISCLOSURE

Often, severe pain or damage to the nervous system is caused by spinalabnormalities. Also, movement of the spinal column may be significantlylimited by such abnormalities. Many of these abnormalities may be theresult of, for example, trauma or degenerative disc disease. Knowntreatments of such abnormalities typically involve affixing screws orhooks to one or more vertebrae and connecting the screws or hooks to arod that is aligned with the longitudinal axis of the spinal column toimmobilize the spinal segments with respect to each other. Pedicle screwsystems are frequently used to provide spinal fixation.

A number of pedicle screw systems are known, which share commontechniques and principles of screw placement and rod attachment.Generally, bone screws are screwed into pedicles of vertebrae andcoupled to at least one elongated rod. The pedicles, which consist of astrong shell of cortical bone and a core of cancellous bone, aregenerally used for the bone screw sites because they provide thestrongest point of attachment of a spine and, thereby, the greatestresistance against bone-metal junction failure. The bone screws may bepositioned so as to traverse all three columns of the vertebrae, therebyproviding ventral and dorsal stability in the spine.

Known pedicle screw systems typically include pedicle screws and rods tostabilize adjacent spinal segments. Such systems also include variableangled coupling caps (or heads) on the pedicle screws to allow forangular adjustment of the coupling mechanism between the rod and screws.Since pedicle size and angulation varies throughout the spinal column,several different sizes and shapes of pedicle screws are used in thesesystems. These systems are generally designed to provide stable andrigid structures to promote bone growth and fusion.

Recovery from spinal surgery is typically a long and arduous processthat places severe restrictions on patient mobility. Accordingly, acontinuing need exists for systems and methodologies that improvepatient recovery and reduce recovery time after surgery.

SUMMARY OF THE DISCLOSURE

The present disclosure is generally directed towards an improvedanchoring system that, among other things, aids in correction ofposterior segmental fusion by adding a bone graft to an implantconstruct, promoting fusion. Exemplary embodiments of the anchoringsystem may include a bone screw system that decorticates, promotesbleeding and promotes creation of a bone graft composition at a base ofthe implantation that will infuse and solidify itself to, for example,the pedicle and the inferior side of a bone screw during the healingprocess. The system also provides an optimal surface area of fusionunder a screw, which decreases the chance of a “windshield-wiper effect”that is sometimes observed in practice with conventional pedicle screws,thereby reducing any chance of screw pullout.

According to an exemplary embodiment of the disclosure, an anchoringsystem for implanting in bone is disclosed. The anchoring systemcomprises a screw assembly that includes a screw head, a screw shaft anda plurality of interface elements. The screw assembly may furtherinclude a boring ring that includes cutting teeth and ring by-passchannels. The anchoring system may further comprise a coupling assembly.The screw assembly may comprise a neck portion located between the screwhead and the plurality of interface elements. The neck portion may beconfigured to receive tissue, blood or bone to promote graft formation.

The interface elements may include interface by-pass channels locatedtherebetween. The interface elements may extend radially from the screwin a direction that is substantially normal to the longitudinal axis ofthe screw. The interface elements may comprise a tapered surface.

The boring ring may be configured to float between the plurality ofinterface elements and the coupling assembly. The boring ring maycomprise an annular portion that facilitates polyaxial angulation,pivoting or rotation of the coupling assembly. The boring ring maycomprise a wall portion that has one or more flat portions that areconfigured to interface with a boring driver.

The coupling assembly may be adjustable with respect to a longitudinalaxis of the screw. The coupling assembly may include a coupling bodythat receives and holds an elongate rod. The coupling assembly mayfurther include a clamp that couples the coupling body to the screwhead. The coupling assembly may include a saddle that attaches to theclamp.

According to another exemplary embodiment of the disclosure, a driverassembly is disclosed. The driver assembly may include a screw driverand a boring driver. The screw driver and boring driver may be usedseparately. The boring driver may include a longitudinal channel that isconfigured to receive and guide the screw driver to engage the headportion of the screw assembly in an anchoring system. The boring drivermay include a handle, a driver shaft, and a driver head. The driver headmay include teeth (or serrations) at its distal end, which may beconfigured to cut into tissue and bone. The driver head may have acavity that is configured to receive the coupling assembly and boringring of the anchoring system. The driver head may include a plurality ofengaging interfaces that are configured to contact and engagecorresponding portions of the ring, thereby engaging and substantiallylocking the boring ring in place with respect to the driver head, sothat when the handle is turned under force of hand and the driver headrotates resultantly, the boring ring is caused to rotate simultaneously.

The driver head may be configured to envelope the entirety of thecoupling assembly and the boring ring of the anchoring system. Thedriver head may include a ring stop to prevent the boring ring fromgoing too deep into the cavity and to maintain the boring ring in anoptimal position to cut into bone by exposing the entirety (or aportion) of the cutting teeth on the lower portion of the boring-ring.The driver head may be configured to allow the boring ring to floatalong the longitudinal axis of the screw assembly.

Additional features and utilities of the exemplary embodiments describedherein may be set forth or apparent from consideration of the detaileddescription and drawings. Moreover, it is to be understood that both theforegoing summary of the disclosure and the following detaileddescription are exemplary and intended to provide further explanationwithout limiting the scope of the disclosure as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure, are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosure andtogether with the detailed description serve to help explain theprinciples of the disclosure. No attempt is made to show structuraldetails of the disclosure in more detail than may be necessary for afundamental understanding of the disclosure and the various ways inwhich it may be practiced. In the drawings:

FIG. 1 shows an exemplary embodiment of an anchoring system;

FIGS. 2A-2C show various views of an exemplary embodiment of a couplingassembly that may be included in the anchoring system of FIG. 1;

FIGS. 3A-3C show various views of an exemplary screw assembly that maybe included in the anchoring system of FIG. 1;

FIGS. 3D-3F show various views of an exemplary screw that may beincluded in the screw assembly of FIGS. 3A-3C;

FIGS. 4A-4F shows various views of an exemplary boring ring that may beincluded in the screw assembly of FIGS. 3A-3C;

FIGS. 5A-5E show various partial views of a portion of the exemplaryembodiment of the anchoring system in FIG. 1;

FIGS. 6A-6C show various views of an exemplary embodiment of a driverassembly that may be used with the anchoring system in FIG. 1;

FIGS. 7A-7H show various views of the bore driver engaging and drivingthe anchoring system of FIG. 1;

FIGS. 8A-8H show various stages of implanting the exemplary anchoringsystem of FIG. 1 into a bone; and

FIGS. 9A-9D show various views of the exemplary anchoring system afterit has been implanted in a bone.

The present disclosure is further described in the detailed descriptionthat follows.

DETAILED DESCRIPTION OF THE DISCLOSURE

The disclosure and the various features and advantageous details thereofare explained more fully with reference to the non-limiting embodimentsand examples that are described and/or illustrated in the accompanyingdrawings and detailed in the following description. It should be notedthat the features illustrated in the drawings are not necessarily drawnto scale, and features of one embodiment may be employed with otherembodiments as the skilled artisan would recognize, even if notexplicitly stated herein. Descriptions of well-known components andprocessing techniques may be omitted so as to not unnecessarily obscurethe embodiments of the disclosure. The examples used herein are intendedmerely to facilitate an understanding of ways in which the disclosuremay be practiced and to further enable those of skill in the art topractice the embodiments of the disclosure. Accordingly, the examplesand embodiments herein should not be construed as limiting the scope ofthe disclosure. Moreover, it is noted that like reference numeralsrepresent similar parts throughout the several views of the drawings.

FIG. 1 shows an embodiment of an anchoring system 100. The anchoringsystem 100 comprises a coupling assembly 110 and a screw assembly 150.The coupling assembly 110 is configured to pivot about and attach to ahead portion (shown in FIG. 3C) of the screw assembly 150. The couplingassembly 110 is configured to be adjustable with respect to thelongitudinal axis of the screw assembly 150. For instance, the couplingassembly 110 is configured to be pivotally, rotationally and angularlyadjustable with respect to the screw assembly 150, including thelongitudinal axis thereof. The various components of the anchoringsystem 100 may be made of a material such as, for example, stainlesssteel, titanium, titanium-alloy, or the like.

FIGS. 2A-2C show various views of a non-limiting embodiment of thecoupling assembly 110. As seen, the coupling assembly 110 includes acoupling body 112, a saddle 114, and a clamp 116. The coupling body 112includes two upwardly extending arms 1122 that extend longitudinally ina superior direction. The coupling body 112 has a pair of slots 1123configured to receive an elongate rod (not shown). As seen, the couplingbody 112 may have a “tulip” shape. The extending arms 1122 have aninterior, an exterior, and upper surfaces. The coupling body 112 isconfigured to receive and hold a cap (not shown) in a predeterminedlocation in the longitudinal direction after insertion in the couplingbody 112, so that a bottom surface of the cap contacts and presses upona surface of the elongate rod to hold the rod in a fixed position,preventing the rod from moving rotationally or longitudinally along thelongitudinal axis of the rod. The coupling body 112 includes a capretaining mechanism, as is known by those skilled in the art, such as,for example, a tongue and grove mechanism, a threading, or the like, toengage the cap and hold it fixedly in the predetermined location in thecoupling body 112.

As the cap (not shown) is inserted (e.g., rotated from a first positionto a second position), the coupling body may include stops (not shown)or other limiting mechanisms to prevent the cap from moving past acertain point and/or from moving back (e.g., rotating back) from apredetermined engaged position whereby the cap exerts a force on therod, as is known by those skilled in the art.

The coupling body 112 is configured to receive and fixedly hold thesaddle 114 and clamp 116. The inner wall of the coupling body 112 mayinclude a protrusion (e.g., tongue) or a recess (e.g., grove) that maybe configured to engage a corresponding recess (e.g., grove) orprotrusion (e.g., tongue) provided on the saddle 114, so as to engageand hold the saddle 114 in a predetermined location in the coupling body112. As seen in FIG. 2C, the saddle 114 may include a recess in aperimeter wall 1146. As noted earlier, the coupling body 112 may haveany other cap retaining mechanism, including, but not limited to, athreading, as understood by those skilled in the art.

As seen in FIG. 2C, the saddle 114 includes an annular body that has anupper surface 1142, a lower surface 1144 and the perimeter wall 1146.The saddle 114 is configured to be inserted into and retained in thecoupling body 112 (e.g., as seen in FIGS. 2B, 5C-5E). The upper surface1142 may be shaped to match the shape of the elongate rod, therebyproviding a substantially snug, contoured fit for the rod against theupper surface 1142. The matching shape of the upper surface 1142 helpsto provide for a more compact coupling body 112 that provides forimproved rigidity of the elongate rod when the rod is secured in thecoupling body 112 by the cap. The outer surface of the perimeter wall1146 is configured to contact an inner wall surface of the coupling body112, as seen in FIGS. 5C-5D. The lower surface 1144 may include a lipportion 1145 formed by the perimeter wall, as seen in FIGS. 5C and 5D.The lip portion 1145 is configured to fasten to a corresponding lipportion 1162 of the clamp 116, as seen in FIGS. 5C and 5D.

The clamp 116 includes an upper portion 1161, a lower portion 1164, andan annular wall 1166. The upper portion 1161 includes the lip portion1162. The lip portion 1162 may be pushed and snapped into the lowerportion of the saddle 114, snapping into place and engaging the lipportion 1145 of the saddle 114, as seen in FIG. 5B. Alternatively, thesaddle 114 may be pushed and the lower lip portion 1145 snapped onto thelip portion 1162 of the clamp 116. The annular wall 1166 has an outersurface and an inner surface. The inner surface may include an internalhelical thread 117 formed on an inner circumference of the annular wall1166, as seen in FIGS. 2A-2B. The thread 117 may be configured to engagea corresponding thread 1342 on the head portion 134 of the screw 130, asillustrated, for example, in FIG. 3C.

Referring back to FIGS. 2A-2C, the coupling assembly 110, including thecoupling body 112, saddle 114 and clamp 116, may be selectively mountedto the screw assembly 150, as illustrated in FIG. 1. The couplingassembly 110 is configured to allow for adjustment, replacement ormodification of specific components of the coupling assembly 110 orscrew assembly 150 without removal of the screw 130 from the bone.

FIGS. 3A-3C show various views of an exemplary embodiment of a screwassembly 150 that may be included in the anchoring system 100 (shown inFIG. 1). As seen in FIGS. 3A-3C, the screw assembly 150 includes a screw130 and a boring ring 120. The screw 130 has a head portion 134, a neckportion 135, an interface portion 136, and a shaft portion 138. The neckportion 135 is located between the head portion 134 and interfaceportion 136. The neck portion 135 may have a radial inward shape, asseen in FIG. 3C.

FIGS. 3D-3F show various detailed views of the screw 130. The headportion 134 may have a spherical shape. The head portion 134 includes athread 1342 on the circumference that is configured to engage the thread117 in the clamp 116 (shown in FIG. 2A). The head portion 134 mayinclude a tool receptacle 132 at its distal end that is configured toreceive a tool (e.g., shown in FIG. 7F). The tool receptacle 132 mayhave a hexagon shape, a torque-screw shape, or any other shape that mayfacilitate the screw 130 being driven into a bone by a tool, such as thescrew driver 210 (shown in FIG. 6A).

Referring to FIG. 3C, the shaft portion 138 may have a thread that isadapted to be screwed into a bone, such as, for example, a vertebrae.However, alternative formations may be formed in the shaft portion 138which provide the intended purposes of securing the screw 130 within abone, as described herein. The shaft 138 may have a tapered shape, whichmay be provided with a high pitch thread. It is noted that the length,diameter, thread pitch, and thread diameter ratio of the shaft 138 maybe selected based on the particular application of the screw 130, asunderstood by those skilled in the art.

Referring to FIG. 3D, the interface portion 136 may include a pluralityof interface elements 1363 extending outwardly from the screw 130. Theinterface elements 1363 are configured to cut tissue and bone. Theinterface portion 136 may include by-pass channels (or graft windows)1364 between each of the interface elements 1363. The interface portion136 may also include a boring ring interface surface 1362 and abone-facing surface 1366. The boring interface surface 1362, which maybe formed by the upper surface of the interface elements 1363, can betapered, thereby facilitating proper seating of the boring ring 120 atopof the interface elements 1363. The bone-facing surface 1366 may betapered. The interface elements 1363 may include sharp cutting edges onthe bone-facing surface 1366 side.

The interface portion 136 is located adjacent to the neck portion 135and shaft 138, and configured to receive fibrous tissue, blood, and bonefrom the cutting teeth 128 of the boring ring 120 (shown in FIGS. 4A-4C)via the by-pass channels 1364 as the screw 130 is advanced into bone.The interface portion 136 is further configured to receive and guidefibrous tissue, blood, and bone from the cutting edges of the interfaceelements 1363. The interface portion 136 guides the fibrous tissue,blood, and bone inward and upward to the neck portion 135 via theby-pass channels 124 on the boring ring (see FIG. 3C) and the by-passchannels 1364 (see FIG. 3D). FIG. 3E shows a bottom view of the screw130 and FIG. 3F shows a top view of the screw 130, including theradially extending interface elements 1363.

FIGS. 4A-4F shows various views of an exemplary embodiment of the boringring 120 that is included in the screw assembly 150.

Referring to FIGS. 4A-4F, the boring ring 120 has a lower portion (shownin FIG. 4F), a wall portion 125 (shown in FIG. 4B) and an upper portion(shown in FIG. 4D). The lower portion may include an interface seatingsurface 126 and cutting teeth 128, as seen in FIG. 4A. The outercircumference of the interface seating surface 126 is greater than theouter circumference of the interface portion 136 of the screw 130 so asto provide a seating area for the interface elements 1363. The interfaceseating surface 126 may be substantially flat or slightly pitched tomatch the tapering angle of the boring ring interface surface 1362 ofthe interface elements 1363. The interface seating surface 126 isconfigured to contact and rest atop the interface elements 1363 (shownin FIGS. 3A-3C). The interface seating surface 126 may have a depth (orheight) that is substantially the same as the height of the distal endsof the interface elements 1363, as illustrated in FIG. 5A. It is notedthat the depth of the interface seating surface 126 may be greater orless than the height of the distal ends of the interface elements 1363.

The cutting teeth 128 are configured to cut fibrous tissue and bone(e.g., cortical bone) as the boring ring 120 is rotated during drivingof the anchor assembly 100 into bone. The boring ring 120 may include aplurality of by-pass channels 124 formed between the cutting teeth 128,as illustrated in FIGS. 4A-4C. The cutting teeth 128 may be configuredto facilitate movement of tissue, blood and bone from the cuttingsurfaces into the by-pass channels 124 and inward toward the neckportion 135 of the screw assembly 150, as illustrated at 810 in FIGS.8G-8H. As illustrated in FIGS. 7G-7H, the width of the by-pass channels1364 in the interface portion 136 may be greater than the width of theby-pass channels 124 in the boring 120.

The wall portion 125 of the boring ring 120 includes a plurality ofteeth along the wall perimeter, with a by-pass channel 124 disposedbetween each of the cutting teeth 128. Referring to FIGS. 4D and 4F, thewall portion 125 may have one or more flat portions that are configuredto interface with a boring driver 220, as illustrated in FIGS. 7G-7H. Inthe embodiment illustrated in FIG. 4D, the wall portion 125 may beformed in the shape of a hexagon, with six flat portions. It is notedthat the wall portion 125 may have any number of flat portions thatinterface with a corresponding boring driver, and the shape of the wallportion 125 is not limited to a hexagon shape, but may have any othershape as those skilled in the art would recognize which would providethe intended purposes of the disclosure as described herein.

The upper portion of the boring ring 120 (shown in FIGS. 4B and 4D) mayinclude an annular portion 122 that is configured to provide clearancefor the coupling body 112 (shown in FIGS. 5A-5E) and a seating portion1252. The annular portion 122 may be provided with a smooth,low-friction surface that facilitates polyaxial angulation, pivoting,and rotation of the coupling assembly 110 with respect to the screwassembly 150, as illustrated in FIGS. 5C-5E. The annular portion 122 mayinclude a radially-shaped surface that is configured to enhancecollection and retention of tissue, blood and bone to facilitate bonegrowth, as illustrated in FIG. 8H. The surface of the annular portion122 may have other shapes, including, for example, but not limited to, atapered shape, an L-shape, or the like. The shape of the annular portion122 may depend on the shape of the coupling body 112, as those skilledin the art would recognize.

Referring to FIG. 4B and FIG. 5B, the outer circumference of the seatingportion 1252 is greater than the outer circumference of the portion ofthe coupling body 112 (see FIG. 2C) that may contact the annular portion122, to avoid obstructing movement of the coupling assembly 110 withrespect to the screw assembly 150.

When the anchor assembly 100 is driven into bone, the longitudinal axisof the coupling assembly 110 may be aligned with the longitudinal axisof the screw assembly 150, and the boring ring 120 may be biased in asubstantially orthogonal position by the contact surface of the lowerportion of the coupling assembly 110 (shown in FIG. 5B) and the engaginginterface of the boring driver (shown in FIGS. 8C-8D). Thisconfiguration assists with optimal anchoring of the anchoring system 100into bone, providing maximum surface contact between the lower portionof the ring 120, coupling assembly 110 and bone.

As seen in FIGS. 5A-5E, the coupling assembly 110 may be pivotally,rotationally and angularly adjustable with respect to the screw assembly150. Furthermore, the boring ring 120 may be configured to float alongthe longitudinal axis of the screw assembly 150, moving (or floating)between the interface portion 136 of the screw 130 and the lower portionof the coupling assembly 110, as seen in FIGS. 5A and 5B, respectively.The floating configuration of the boring ring 120 facilitates enhanced,inward, upward and radial movement of tissue, blood and bone about theneck portion 135 of the screw 130, between the coupling assembly 110 andinterface portion 136 of the screw 130. The tissue, blood and bone thatis forced up through the by-pass channels and located around and in theanchoring system 100 generates a form of bone graft, as seen in FIGS.8G-8H.

After insertion of the anchor system 100 in bone (e.g., as seen in FIGS.8A-8H), the coupling assembly 110 may be pivoted, rotated, and/orangularly adjusted to a desired position, as seen in FIGS. 5C-5E, toallow for proper rod alignment and placement. As illustrated in FIGS.9A-9B, graft material may be left inside the by-pass channels 124 of theboring ring 120, including the outer by-pass channels 124 of the wallportion 125, as illustrated at 820 in FIG. 9B.

FIGS. 6A-6C show various views of the driver assembly 200 that may beused with the anchoring system 100 (shown in FIG. 1). The driverassembly 200 may include a screw driver 210 and a boring driver 220. Thescrew driver 210 and boring driver 220 may be used separately. Theboring driver 220 may include a longitudinal channel as seen in FIG. 6Cthat is configured to receive and guide the screw driver 210 to engagethe head portion of a pedicle screw, as discussed below.

FIGS. 7A-7H illustrate various views of the boring driver 220. Referringto FIG. 7A, the boring driver 220 may include a handle 222, a drivershaft 224, and a driver head 226. The driver head 226 may include teeth(or serrations) 2262 at its distal end, which are configured to cut intotissue and bone. As seen in FIGS. 7B and 7C, the driver head 226 mayhave a cavity 2264 that is configured to receive the coupling assembly110 and boring ring 120 (shown in FIGS. 8G-8H). The driver head 226 mayalso include a plurality of engaging interfaces that are configured tocontact and engage the corresponding flat portions of the ring 120(shown in FIG. 4A), thereby engaging and substantially locking theboring ring 120 in place with respect to the driver head 226, so thatwhen the handle 222 is turned under force of hand and the driver head126 rotates resultantly, the boring ring 120 is caused to rotatesimultaneously. For example, the driver head 226 may have six engaginginterfaces that engage the six corresponding flat portions of the boringring 120.

As illustrated in FIGS. 7D-7H, driver head 226 may be configured toenvelope the entirety of the coupling assembly 110 and the boring ring120. The driver head 226 may include a ring stop 2266 (shown in FIG. 7F)to prevent the boring ring from going too deep into the cavity 2264 andto maintain the boring ring 120 in an optimal position to cut into boneby exposing the entirety (or a portion) of the cutting teeth on thelower portion of the boring-ring 120. The driver head 226 may beconfigured to allow the boring ring 120 to float along the longitudinalaxis of the screw assembly 150.

As noted earlier, the boring driver 220 may include a longitudinalchannel along the entire length of the boring driver 220. The channelmay be positioned centrally along the longitudinal axis of the boringdriver 220. The channel may be configured to receive and guide the headand shaft portion of the screw driver 210 to the driver head 226, so asto engage and drive the receptacle 132 in the head portion of the screw130 when driving the anchoring system 100 into bone.

FIGS. 8A-8H illustrate various stages of implanting the anchoring system100, according to principles of the disclosure, which will be referredto herein to describe a non-limiting example of an application of thedisclosure.

After a surgical area is cleaned on the patient, an incision is made,the muscle tissue is moved to the side(s), and other common surgicalprocedures are carried out, tracks for the pedicle screws may beprepared. In this regard, hard bone surface may be removed and a guidetrack may be inserted under x-ray guidance into the pedicle of thevertebrae. The depth and position of the guide track may be checked.Then a thread is tapped into the bone for the anchoring system 100. Theprocess would be repeated for each implant of the anchoring system 100.

Referring to FIG. 7F, the anchoring system 100 may be placed in thedriver head 226 of the boring driver 220 and the head and shaft of thescrew driver 210 inserted into the channel of the boring driver 220. Thescrew driver 210 may be moved downward and manipulated until the screwdriver 210 head is sufficiently seated in and engaged with the screwhead 134 to ensure a secure connection. The driver assembly 200,including the anchoring system 100, can then be aligned with the tap inthe bone, as illustrated in FIGS. 8A and 8B, and screwed into thethreaded tap in the bone using the driver assembly 200. Throughmanipulation of one or both of the handles on the screw driver 210 andboring driver 220, the surgeon may selectively drive the screw 130 intothe bone and/or the boring ring 120 and boring driver head 226 to cuttissue and/or bone.

For instance, referring to FIGS. 8G and 8H, the surgeon may advance thescrew 130 into the bone tap by turning the handle of the screw driver210 and then switching over and turning the handle of the boring driver220 to drive the boring driver head 226 and boring ring 120 to cut intobone and move the boring ring 120 from the position shown in FIG. 8G tothe position shown in FIG. 8H.

Once the anchoring system 100 is implanted in the desired position, thescrew driver 210 may be removed and the coupling assembly 110 may bepivoted, angularly adjusted, or rotated. The coupling assembly 110 maybe manipulated by, for example, retracting the boring driver 220 untilthe boring ring 120 is completely free of the boring driver head 226 andthen manipulated to position the coupling assembly 110 in the desiredposition and angle. This process is repeated for each pedicle screwbefore the rest of the surgical procedure is carried out, including rodplacement.

FIGS. 9A-9D show various views of the anchoring system 100 after it hasbeen implanted in bone. FIGS. 9A and 9B show a cross-section cut viewand a side view, respectively, of the anchoring system 100 after theboring driver 220 and screw driver 210 (shown in FIG. 8A) are removed.As seen in FIGS. 9A and 9B, the graft material may be left inside theby-pass channels 124 of the boring ring 120, including the outer by-passchannels of the wall portion 125, as seen at 820 in FIG. 9B, to promotegraft formation.

FIG. 9C shows a partial view of a completed placement of the anchoringsystem 100 in a pedicle of the vertebra. FIG. 9D shows a perspective,substantially complete view of the vertebra with completed placement ofthe anchoring system 100 in both of the pedicles of the vertebra. Asseen in FIGS. 9C and 9D, the coupling assemblies 110 of the anchoringsystems 100 may be positioned so that the slots 1123 of the couplingbodies 112 are aligned with the slots of coupling bodies (not shown) ofanchoring systems located on an adjacent vertebra (not shown). Theanchoring systems of the pair of vertebrae may then be cross-connectedusing, for example, elongate rods, and the rods may be locked in placeby, for example, caps screwed into each of the coupling assemblies, asis known in the art.

The terms “including,” “comprising,” and variations thereof, as used inthis disclosure, mean “including, but not limited to,” unless expresslyspecified otherwise.

The terms “a,” “an,” and “the,” as used in this disclosure, means “oneor more,” unless expressly specified otherwise.

Devices that are in communication with each other need not be incontinuous communication with each other, unless expressly specifiedotherwise. In addition, devices that are in communication with eachother may communicate directly or indirectly through one or moreintermediaries.

Although process steps, method steps, algorithms, or the like, may bedescribed in a sequential order, such processes, methods and algorithmsmay be configured to work in alternate orders. In other words, anysequence or order of steps that may be described does not necessarilyindicate a requirement that the steps be performed in that order. Thesteps of the processes, methods or algorithms described herein may beperformed in any order practical. Further, some steps may be performedsimultaneously.

When a single device or article is described herein, it will be readilyapparent that more than one device or article may be used in place of asingle device or article. Similarly, where more than one device orarticle is described herein, it will be readily apparent that a singledevice or article may be used in place of the more than one device orarticle. The functionality or the features of a device may bealternatively embodied by one or more other devices which are notexplicitly described as having such functionality or features.

While the disclosure has been described in terms of exemplaryembodiments, those skilled in the art will recognize that the disclosurecan be practiced with modifications in the spirit and scope of theappended claims. These examples are merely illustrative and are notmeant to be an exhaustive list of all possible designs, embodiments,applications or modifications of the disclosure.

What is claimed is:
 1. An anchoring system comprising: a screw system comprising: a screw including a screw head, a screw shaft and a plurality of interface elements, each pair of the interface elements having an interface by-pass channel located therebetween; a boring ring including an upper surface, a lower surface, a wall portion extending between the upper surface and the lower surface, and a plurality of cutting teeth along the wall portion extending longitudinally from the upper surface to the lower surface; and a coupling assembly that is adjustable with respect to a longitudinal axis of the screw, the coupling assembly being adapted to attach to the screw head; and a driver comprising a handle, a driver shaft, and a driver head having a cavity configured to receive the coupling assembly and the boring ring, wherein the driver head includes teeth at its distal end configured to cut into tissue and bone.
 2. The anchoring system of claim 1, wherein the driver head includes a plurality of engaging interfaces that are configured to contact and engage corresponding flat portions of the boring ring.
 3. The anchoring system of claim 1, wherein the driver head includes a ring stop to prevent the boring ring from recessing too deep into the cavity.
 4. The anchoring system of claim 1, wherein the coupling assembly comprises a coupling body that receives and holds an elongate rod and a clamp that couples the coupling body to the screw head.
 5. The anchoring system of claim 4, wherein the coupling assembly further comprises a saddle that attaches to the clamp.
 6. The anchoring system of claim 1, wherein the plurality of interface elements extend radially from the screw in a direction that is substantially normal to the longitudinal axis of the screw.
 7. The anchoring system of claim 1, wherein the plurality of interface elements comprise a tapered surface.
 8. The anchoring system of claim 1, wherein the screw further includes a neck portion located between the screw head and the plurality of interface elements.
 9. The anchoring system of claim 8, wherein the neck portion is configured to receive tissue, blood and bone to promote graft formation.
 10. The anchoring system of claim 1, wherein the boring ring is configured to float between the plurality of interface elements and the coupling assembly.
 11. The anchoring system of claim 1, wherein the boring ring includes an annular portion that facilitates polyaxial angulation, pivoting and rotation of the coupling assembly.
 12. An anchoring system comprising: a screw assembly comprising: a screw including a screw head and a plurality of interface elements; a boring ring including an upper surface, a lower surface, a wall portion extending between the upper surface and the lower surface, and a plurality of cutting teeth along the wall portion extending longitudinally from the upper surface to the lower surface; and a coupling assembly that attaches to the screw head, wherein the boring ring is positioned between the plurality of interface elements and the coupling assembly; and a driver comprising a handle, a driver shaft, and a driver head having a cavity configured to receive the coupling assembly and the boring ring, wherein the driver head includes teeth at its distal end configured to cut into tissue and bone.
 13. The anchoring system of claim 12, wherein the driver head includes a plurality of engaging interfaces that are configured to contact and engage corresponding flat portions of the boring ring.
 14. The anchoring system of claim 12, wherein the driver head includes a ring stop to prevent the boring ring from recessing too deep into the cavity.
 15. The anchoring system of claim 12, further comprising a by-pass channel disposed between each adjacent pair of the plurality of interface elements.
 16. The anchoring system of claim 12, wherein the coupling assembly comprises a coupling body that receives and holds an elongate rod, a clamp that attaches the coupling body to the screw head, and a saddle that attaches to the clamp.
 17. The anchoring system of claim 12, wherein the plurality of interface elements extend radially from the screw in a direction that is substantially normal to a longitudinal axis of the screw.
 18. The anchoring system of claim 12, wherein the screw further includes a neck portion located between the screw head and the plurality of interface elements. 